First guideline on colorectal cancer care launched to promote best practice
NICE has set out recommendations for the treatment of colorectal cancer from diagnosis through to management, ongoing care and support.
Colorectal cancer is the third most common form of cancer in the UK, and around 40,000 new cases are registered per year.
It is also the second most likely cause of cancer-related death in the UK and is closely linked to age, with nearly three-quarters of cases occurring in people aged 65 or over.
Colorectal cancer is, however, treatable but needs to be identified early on.
This latest guidance recommends that people who are suspected of having colorectal cancer, who do not have any other major underlying illness or condition, should be offered a colonoscopy to confirm the diagnosis.
If a lesion suspected of being cancer is detected, a biopsy should be performed to obtain histological proof of diagnosis.
A healthcare team should assess the stage of the colorectal cancer to determine whether it has spread. This should be done by offering a contrast-enhanced CT (computed tomography) scan of the person's chest, abdomen and pelvis.
If the CT scan shows that the tumour has only spread to the liver, and the patient has no other underlying conditions preventing further treatment, a specialist multidisciplinary team should decide if further imaging is necessary. This is to confirm whether surgery is suitable, or potentially suitable, for the patient.
If the person has rectal cancer, they should be offered an MRI scan. Information from this will help the healthcare team decide on further treatment based on an assessment of the risk of local recurrence.
There are two treatments for shrinking tumours before surgery for those with rectal tumours that cannot be operated on immediately - short-course radiotherapy and chemoradiotherapy. Neither treatment should be offered to patients with low-risk operable cancer, unless as part of a clinical trial.
The guideline states that healthcare professionals offering multiple chemotherapy drugs to patients with advanced colorectal cancer and metastatic cancer (tumours that have spread to other parts of the body), should consider one of three sequences of chemotherapy.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said "This is the first NICE guideline to look at how best to diagnose and manage colorectal cancer and its aim is to help ensure patients are diagnosed quickly and accurately and receive the best possible care.
"Recommendations made in this new guideline emphasise the importance of ensuring patients have all the information they need, to enable them to make better informed decisions about their care, improving their quality of life during and after treatment."
Mr Graeme Poston, Chair of the guideline development group and Consultant Surgeon, Aintree University Hospital NHS Foundation Trust, said: "We believe that these guidelines will improve the diagnosis and treatment of colorectal cancer at every stage of the patient journey, and end any post code lottery of care to which patients have previously endured."
A range of implementation tools have been published to help support the use of this guideline. These include a slide set, a costing template and an audit tool.
A case study is also available to download from our website. This is an educational resource aimed at organisations based on the Merseyside and Cheshire Cancer Network model for establishing early rectal cancer multidisciplinary teams.
9 November 2011